December 22, 2020
On December 20, 2020, the Advisory Committee on Immunization Practices (ACIP), responsible for recommendations on US adult and childhood immunizations, voted to recommend the Moderna COVID-19 vaccine for persons age 18 and older under the Food and Drug Administration’s (FDA’s) Emergency Use Authorization. This makes the Moderna’s the second authorized and recommended COVID-19 vaccine, after the Pfizer-BioNTech vaccine, which was authorized and recommended for persons age 16 and older.
Under the CARES Act and implementing regulations, all group health plans—insured and self-insured—are required to cover ACIP recommended vaccines with no cost-sharing (no copays, coinsurance, deductibles). Additional details on the Moderna and Pfizer-BioNTech vaccines are available in the ACIP meeting materials.
ACIP also updated its recommendations on the priority of groups receiving COVID-19 vaccinations when supply is limited, as follows:
- Phase 1a | Health care personnel, long-term care facility residents
- Phase 1b | Persons aged 75 years+, frontline essential workers
- Phase 1c | Persons aged 65-74, persons aged 16-64 with high-risk medical conditions, other essential workers
Although states ultimately determine the allocation of COVID-19 vaccines, these ACIP recommendations inform states’ decisions.
Employer-sponsored group health plans must cover the Moderna vaccine, without cost-sharing, within 15 business days after the vaccine is recommended by ACIP and the Centers for Disease Control and Prevention. Therefore, we recommend that group health plans be prepared to cover the Moderna COVID-19 vaccine by January 8, 2021.
We expect that in the coming weeks and months, the FDA and ACIP will authorize and recommend additional COVID-19 vaccines that group health plans must then cover without cost-sharing. We also expect that other agencies will issue more specific guidance on COVID-19 vaccine coverage. We will keep our members updated of any new recommendations, guidance, and effective dates.
We will provide a more detailed discussion of this and other COVID-19-related guidance in our next regulatory and compliance webinar on January 21, 2021 at 12:30PM ET. Members can register here.
If you have questions, comments, or concerns about these or other regulatory and compliance issues, please contact us.
We provide this material for informational purposes only; it is not a substitute for legal advice.